o The new “prevention through health care” focus area appears to be duplicative of “public
health emergency preparedness” – this may dilute the importance of IPC without really adding anything new.
WHO advised that there is no intention to detract from IPC, but rather to link it to the
wider role of health-care facilities in interrupting transmission, addressing AMR and minimizing the risk of further spread through health-care-associated transmission.
o Public health emergency planning needs to reflect a whole-of-government approach. This is
exemplified in pandemic preparedness, which requires the resources, expertise and capabilities of multiple agencies to be deployed in a coordinated fashion.
2.4 Plenary 3: APSED III focus areas 1
–3
The session chair, Dr Liu Haitao, introduced the session reviewing APSED III focus areas 1
–3. During this session, progress, challenges and new elements were presented for the following focus areas: public health emergency preparedness Focus Area 1; surveillance, risk assessment and
response Focus Area 2; and laboratories Focus Area 3. These were then the subject of group work sessions by all participants.
Participants were invited to review the draft expected outcomes and strategic actions. They were requested to comment on any changes required and assess them as proposals for implementation.
2.5 Plenary 4: Implementing, monitoring and evaluating APSED
The session chair, Mr Rady, introduced the session, reminding participants of the direct and indirect benefits of monitoring and evaluation.
Implementing APSED III
Dr Olowokure stated that APSED III will retain a step-wise, country-centred approach, providing a generic platform for Member States to meet IHR 2005 obligations. The revised strategy
will allow countries flexibility to address emerging threats and provi de ‘signposts’ to help them
engage with other strategic initiatives and programmes such as the SDGs, UHC and the Pandemic Influenza Preparedness Framework. There needs to be effective mechanisms at the national level to
manage and coordinate APSED planning and implementation. Ongoing coordination within and between Member States, WHO and other partners will be needed for successful implementation.
Member States may wish to consider establishing a mechanism, or using existing interagency structures, to lead the next phase of planning and to review progress. There are a number of
regional-level mechanisms for APSED implementation. The annual TAG meeting will provide guidance on implementation of APSED III, and support strategic monitoring and evaluation activities
to assist countries with priority setting and implementation. The regional committees and high-level meetings of ministers will provide endorsement and political commitment for implementation of
APSED III. It is anticipated that donors and technical partners will remain engaged with APSED as they fulfil a vital role in mobilizing resources and expertise to support capacity-building. WHO will
also continue to work with countries and partners to support and coordinate preparedness activities.
Monitoring and evaluation under APSED and IHR 2005
Dr Sreedharan and Ms Sarah Hamid discussed the global monitoring and evaluation ME activities as primarily guided by the core capacities specified in Annex 1 of IHR 2005. Post-Ebola
urgency remains in relation to the continuing efforts to strengthen core capacities, including linkages with other initiatives, such as the G7 and bilateral collaboration between Member States, as
encouraged under Article 44. Work on the new ME framework arose from the 2014 report of the IHR Review Committee, as endorsed by the World Health Assembly resolution WHA 68.5.
The post-2016 IHR-MEF is comprised of four components: annual reporting, AAR, exercises and JEE. Key features of JEE include its voluntary, multisectoral nature and the goal of promoting
transparency. The new IHR-MEF is consistent with APSED in recognizing the value of annual reporting, AARs, joint WHO
–Member State evaluation, and simulation exercises, such as PanStop
practising rapid containment of a preliminary outbreak of influenza with pandemic potential and the annual IHR Exercise Crystal. APSED ME integrates both national-level and regional elements
of ME mechanisms in a flexible and cyclical process. An important and enduring feature of APSED ME is the annual review by TAG and Member States. APSED ME is well aligned with,
and helped to inform the design of, the newly developed global IHR-MEF.
Country experiences with JEE: Cambodia
Dr Ly Sovann presented on Cambodia’s experience with JEE. Cambodia applied for and was granted a second two-year IHR extension. The extension and JEE provided an opportunity to develop
a new national action plan for EIDs and public health emergencies, which makes full use of the APSED framework. The process began with a self-evaluation using the JEE Tool. The JEE process
itself involved 11 separate working groups, each focusing on a specific area of activity. The working groups sourced and reviewed the available evidence
– this in itself was a challenging but ultimately worthwhile task. Reviewing the documentation helped identify gaps, priorities for planning and
relevant government resources. A new national plan for 2016 –2020 was prepared. Key elements of
the plan include leadership and coordination, surveillance, risk communication, AMR, IPC and point of entry POE. The new plan sets out objectives, activities, time frames, implementation leads and
resources. It also references pre-existing plans such as for laboratories. The JEE and development process led to some informal functions being strengthened by more formalized arrangements.
The process also highlighted the need for changes to legislation and the development of written standard operating procedures SOPs. Intersectoral exercises are scheduled to test the plan, including
for food safety. The planning process also proved to be an effective vehicle for engagement with donors and technical partners. The initial self-evaluation was useful in its own right and also helped to
prepare for the subsequent JEE.
Country experiences with JEE: Bangladesh
Dr Rahman stated that GHSA was launched in February 2014 and now covers nearly 50 countries and international organizations. It is a voluntary, collaborative process involving
19 action packages and technical areas. The process begins with an initial self-assessment followed by a more thorough review. It allows countries to identify capacity gaps and objectively plan actions
for improving preparedness. The framework addresses “prevent, detect and respond” components, supplemented with other supporting elements. In Bangladesh, 25 institutions and organizations were
involved in the evaluation process, including visits to human and animal health laboratories and human health facilities. Priority areas included coordination within and between different
sectorsagencies, legislation, funding and zoonoses. A key lesson was the need to commit to and resource the development, validation and promulgation of plans, SOPs, documentation, etc. At the
conclusion of the process, the JEE core team debriefed senior health officials and policy-makers.
The Chair invited questions and comments: o
How can we best integrate multiple frameworks such as IHR, APSED and JEE and what should be the coordinating mechanism?
These frameworks are all complementary. For example, the initial self-assessment
demonstrates country commitment to, and ownership of, the process. It also provides an opportunity to bring various government stakeholders together, sometimes for the
first time. This process of engagement helps to put in place a coordination mechanism. It also helps to reinforce that IHR requires a whole-of-government
approach and that it is not just the responsibility of the ministry of health. In broad terms, IHR, APSED and JEE are all aligned but work at different levels. The IHR sets
out the core obligations of Member States, APSED provides a framework for action to implement IHR requirements, and the JEE process assists countries to assess their
progress and inform decisions as how to best move forward.
o Dr Kasai noted that JEE does not replace annual self-assessments but rather supplements
them, and in so doing reinforces the process of continuous review and improvement.
o What is the relationship between APSED and GHSA?
APSED is a 10-year-old strategy developed for the implementation of IHR 2005 in
the South-East Asia and Western Pacific regions. APSED takes an all-hazards approach and has helped to inform global IHR activities such the new JEE Tool.
The GHSA is a more recent international effort that focuses on many but not all of the IHR areas in particular it focuses on biological hazards and includes chemical and
radiological risks. The GHSA also pays closer attention to some specific threats that IHR addresses only in a generic way for example, bioterrorism. The GHSA can
therefore be seen as complementary to and a subset of IHR 2005.
o APSED is more than a document or plan. It is an ongoing process, involving discussion and
the sharing of experiences, challenges and lessons learnt. It is a dynamic process based on trust, mutual respect and a willingness to work collectively towards public health security.
2.6 Panel discussion: How APSED III connects with other strategies and initiatives
The panel discussion was moderated by Mr Matthew Johns, United States Department of Health and Human Services, and Dr Darren Hunt, consultant, WHO Regional Office for the
Western Pacific. The panel members were Professor Mahmudur Rahman, former Director, Institute of
Epidemiology, Disease Control and Research, Bangladesh; Mr Marcus Samo, Assistant Secretary for Health, Federated States of Micronesia; and Dr Mohd Nasir Hasan, Ms Anjana Bhushan, Dr Xu Ke,
WHO Regional Office for the Western Pacific.
Health system strengthening HSS, UHC and the SDGs are all directly relevant to APSED, IHR, capacity-building and public health emergency preparedness. They address the governance of,
funding for and accountability of health services. HSS is a framework for the overall architecture of health services and is the foundation for preparing and responding to health emergencies. APSED III
sets out eight focus areas for capacity-building, all of which contribute to HSS, UHC and the SDGs. In combination, they strengthen health systems and support wider social and economic resilience.
Countries need to carefully balance the sourcing and allocation of resources, including what funds are available domestically and what resources are provided by donors and other partners.
AMR was recognized globally in 2014 not as a future threat, but as a current one. Across the world, millions of cases and many tens of thousands of deaths annually are attributable to AMR.
This carries an enormous social and economic cost, and is expected to only increase in terms of the burden of disease. This fact is recognized in APSED III as a parallel universal challenge, along with
EIDs. Synergies between APSED III and actions to address AMR include the role of laboratories, collaboration between the human and animal health sectors for example, in relation to zoonoses and
especially the need for further progress with IPC in clinical care. A One Health approach can help to underpin implementation of both APSED and the AMR global action plan.
The SDGs envisage an interconnected web of development and well-being, involving multiple sectors working at different levels. The approach taken by the SDGs goes beyond a
whole-of-government model to a whole-of-society paradigm. This incorporates the roles of civil society, local government and the private sector, as well as reflecting themes such as gender equity
and human rights. Implementing the SDGs will require us to think and work differently, adopting a truly long-term, collective and preventive mindset, while still focusing on concrete actions in the short
term. The health sector cannot of course lead all the actions required, but in many ways can inform and influence the decisions and actions of other sectors.
Extreme weather events cause complex health and environmental effects and are expected to be exacerbated by climate change. The Pacific in particular experiences major challenges associated
with cyclones, flooding, droughts and rising sea levels. Pacific island countries and areas face ongoing challenges from extreme weather events and also must prepare for and respond from a low baseline of
human and economic resources. In this context, collective actions and partnerships are essential to societal and health systems resilience. In practical terms, APSED III drives countries towards
